Health Law and Regulation

The performance of physician practices can be reliably measured by using a composite of quality measures, according to research led by Sherrie Kaplan, Ph.D., M.P.H. of the University of California at Irvine and co-authored by NCQA executive vice president Dr. Greg Pawlson.

Findings published in Medical Care used data from NCQA-recognized physicians suggests that physician practices can be distributed into three levels of relative quality (high, average, low) when a cluster of measures, rather than a single measure, is used to differentiate performance.

Researchers used data submitted by physicians who were recognized in the NCQA Diabetes Physician Recognition Program. Using a sample of 35 patients from each practice, the research team analyzed data from 11 diabetes measures. They found that combining performance on five to nine measures could reliably separate practices into three levels of quality.

“This research suggests that evaluating physician practices for pay-for-performance (PFP) or similar programs can be a sound process when based on selected measure composites,” said Dr. Pawlson. “As we move further into the widespread use of evaluation at the physician practice level, careful testing and evaluation of the evaluation methodology is critical for ensuring that the information is accurate and draws fair conclusions. Composite measures appear to offer a substantial advantage over individual or unrelated measures in this effort.”

Evaluation programs need to use a carefully selected set of measures to be meaningful. “Our study underscores the importance of setting thresholds for the measures that reflect the degree of physician influence or impact on the measures,” said Dr. Kaplan. “Identifying thresholds that reflect physician impact in contrast to the influence of the other factors, like patient characteristics, is of critical importance for fair and reliable performance assessment.”

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Source: Executive Report on Managed Care, May 2009

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